Maíra Teixeira Dória1, Jonathan Yugo Maesaka2, Raymundo Soares de Azevedo Neto3, Nestor de Barros4, Edmund Chada Baracat2, José Roberto Filassi2. 1. Department of Obstetrics and Gynecology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil. Electronic address: maira_doria@yahoo.com.br. 2. Department of Obstetrics and Gynecology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil. 3. Department of Pathology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil. 4. Department of Radiology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
Abstract
BACKGROUND: Approximately 30% of ductal carcinoma in situ (DCIS) cases have an invasive component discovered on the final analysis that could affect surgical management. The aims of the present study were to determine the risk factors associated with the underestimation of DCIS and to develop a model to predict the probability of invasiveness. MATERIALS AND METHODS: A retrospective analysis was performed on the data for all patients with a diagnosis of DCIS found by percutaneous biopsy from January 2008 to February 2016. Thirteen potential predictors of invasiveness were examined. The statistical analysis of the present study was improved using Nagelkerke's R2, the area under the receiving operating characteristic (AUC) curve, and the Hosmer-Lemeshow goodness-of-fit test. RESULTS: Of 354 biopsy specimens deemed to be DCIS on initial biopsy, 100 (28.2%) were recategorized as invasive carcinoma after surgery. On multivariate analysis, the strongest predictors of invasiveness were comedonecrosis, size on mammography, suspected microinvasion, histologic grade, and younger patient age. The model had a good discriminative ability, with an AUC of 0.764. The overall performance of the model was fair, with a Nagelkerke's R2 of 40.9%. A separate analysis performed on 274 specimens obtained through vacuum-assisted biopsy revealed different variables were associated with underestimation; however, a similar AUC (0.743) and Nagelkerke's R2 (45.7%) were obtained. CONCLUSION: Our model had the best AUC for predicting DCIS invasiveness reported to date. However, further statistical analysis showed only a fair overall performance. The currently known clinical, radiographic, and pathologic features might be insufficient to identify which patients with DCIS have underestimated disease.
BACKGROUND: Approximately 30% of ductal carcinoma in situ (DCIS) cases have an invasive component discovered on the final analysis that could affect surgical management. The aims of the present study were to determine the risk factors associated with the underestimation of DCIS and to develop a model to predict the probability of invasiveness. MATERIALS AND METHODS: A retrospective analysis was performed on the data for all patients with a diagnosis of DCIS found by percutaneous biopsy from January 2008 to February 2016. Thirteen potential predictors of invasiveness were examined. The statistical analysis of the present study was improved using Nagelkerke's R2, the area under the receiving operating characteristic (AUC) curve, and the Hosmer-Lemeshow goodness-of-fit test. RESULTS: Of 354 biopsy specimens deemed to be DCIS on initial biopsy, 100 (28.2%) were recategorized as invasive carcinoma after surgery. On multivariate analysis, the strongest predictors of invasiveness were comedonecrosis, size on mammography, suspected microinvasion, histologic grade, and younger patient age. The model had a good discriminative ability, with an AUC of 0.764. The overall performance of the model was fair, with a Nagelkerke's R2 of 40.9%. A separate analysis performed on 274 specimens obtained through vacuum-assisted biopsy revealed different variables were associated with underestimation; however, a similar AUC (0.743) and Nagelkerke's R2 (45.7%) were obtained. CONCLUSION: Our model had the best AUC for predicting DCIS invasiveness reported to date. However, further statistical analysis showed only a fair overall performance. The currently known clinical, radiographic, and pathologic features might be insufficient to identify which patients with DCIS have underestimated disease.
Authors: Guang Chen; Xiao-Fei Ding; Kyle Pressley; Hakim Bouamar; Bingzhi Wang; Guixi Zheng; Larry E Broome; Alia Nazarullah; Andrew J Brenner; Virginia Kaklamani; Ismail Jatoi; Lu-Zhe Sun Journal: Clin Cancer Res Date: 2019-12-23 Impact factor: 12.531